title: The choice of alternatives to acute hospitalization: a descriptive study from Hallingdal, Norway.
abstract: BACKGROUND
  Hallingdal is a rural region in southern Norway. General practitioners (GPs) refer acutely somatically ill patients to any of three levels of care: municipal nursing homes, the regional community hospital or the local general hospital. The objective of this paper is to describe the patterns of referrals to the three different somatic emergency service levels in Hallingdal and to elucidate possible explanations for the differences in referrals.
  
  
  METHODS
  Quantitative methods were used to analyse local patient statistics and qualitative methods including focus group interviews were used to explore differences in referral rates between GPs. The acute somatic admissions from the six municipalities of Hallingdal were analysed for the two-year period 2010-11 (n = 1777). A focus group interview was held with the chief municipal medical officers of the six municipalities. The main outcome measure was the numbers of admissions to the three different levels of acute care in 2010-11. Reflections of the focus group members about the differences in admission patterns were also analysed.
  
  
  RESULTS
  Acute admissions at a level lower than the local general hospital ranged from 9% to 29% between the municipalities. Foremost among the local factors affecting the individual doctor's admission practice were the geographical distance to the different places of care and the GP's working experience in the local community.
  
  
  CONCLUSIONS
  The experience from Hallingdal demonstrates that GPs use available alternatives to hospitalization but to varying degrees. This can be explained by socio-demographic factors and factors related to the medical reasons for admission. However, there are also important local factors related to the individual GP and the structural preparedness for alternatives in the community.
authors.affiliation: Department of Hallingdal Sjukestugu, Medical Clinic of Ringerike General Hospital, Vestre Viken Hospital Trust, Ål, Norway. oystein.lappegard@vestreviken.no
authors.forename: Oystein
authors.initials: O
authors.lastname: Lappegard
authors.forename: Per
authors.initials: P
authors.lastname: Hjortdahl
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000369:Aged, 80 and over; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D009111:Local Government; D009664:Norway; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D010561:Personnel Staffing and Scheduling; D008486:Physician Executives / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012424:Rural Population; D012959:Socioeconomic Factors